Meningomyelosel ve Ensefalosel Onarımı İçin Anestezi Yönetimi: 58 Olgunun Gözden Geçirilmesi

Yıl 2023, Cilt: 18 Sayı: 1, 177 - 182, 16.03.2023

Gökçe Gişi

https://doi.org/10.17517/ksutfd.1246748

Öz

Amaç: Meningomyelosel ve ensefaloseller acil onarım gerektiren ve çoğunlukla doğum sonrası erken dönemde alınan pediatrik nöroanestezi vakalarıdır.
Zor havayolu, eşlik eden konjenital malformasyonlar, kanama, hemodinamik bozukluklar ve pron pozisyonu sebebiyle anestezi yönetimi bilgi, dikkat ve deneyim
gerektirir. Bu çalışmanın amacı kurumumuzda alınan meningomyelosel ve ensefaloselin cerrahi onarımı için anestezi yönetimini gözden geçirmekti.
Gereç ve Yöntemler: Ocak 2018-Aralık 2022 tarihleri arası kurumumuzda meningosel ve ensefalosel onarımı cerrahisi geçiren 58 hasta çalışmaya alındı.
Hastaların demografik özellikleri, anestezi süresi, eşlik eden anomalileri, intraoperatif ve postoperatif komplikasyonları anestezi takip formlarından ve
elektronik ortamdaki kayıtlarından elde edilerek retrospektif olarak değerlendirildi.
Bulgular: Çalışmada 45 meningomyelosel ve 13 ensefalosel onarımı için opere edilen toplam 58 yenidoğan ve infant incelendi. Hastaların 32’si (%55.2)
kız bebek, 26’sı (%44.8) erkek bebekti. Yaş ortanca değeri 3 gündü. Kardiyak, solunumsal anomaliler ve hidrosefali en sık eşlik eden sorunlardı. Beş zor
entübasyon vakası vardı. Major anestezi komplikasyonu olmadı.
Sonuç: Meningomyelosel ve ensefaloselli bebeklerin yönetimi, perioperatif yönetimde karşılaşılan olası zorluklarla ilgili güncel bilgileri gerektirir. Zor hava
yolu, konjenital anomalilerin varlığı, pron pozisyonu ve kardiyorespiratuar bozukluklarla başa çıkmak için özel anestezik bakım gerekir. Dikkatli preoperatif
hazırlık, titiz intraoperatif yönetim başarılı bir anestezi uygulaması için çok önemlidir.

Anahtar Kelimeler

Anestezi yönetimi, Ensefalosel, Meningomiyelosel, Zor entübasyon

Anesthesia management for surgical correction of meningomyelocele and encephalocele: a review of 58 Cases

Öz

Objective: Meningomyelocele and encephaloceles are pediatric neuroanesthesia cases that require urgent surgical correction and are mostly taken in the early
postnatal period. Anesthesia management requires information, attention and experience due to difficult airway, accompanying congenital malformations,
bleeding, hemodynamic disorders and prone position. The aim of this study was to review anesthesia management for surgical correction of meningomyelocele
and encephalocele received in our institution.
Materials and Methods: A total of 58 patients who underwent meningocele and encephalocele correction surgery in our institution between January 2018
and December 2022 were included in the study. Demographic characteristics, duration of anesthesia, accompanying anomalies, intraoperative and postoperative
complications of the patients were obtained from anesthesia follow-up forms and electronic records and evaluated retrospectively.
Results: A total of 58 newborns and infants who were operated for repair of 45 meningomyeloceles and 13 encephaloceles were examined in the study. Of
the patients, 32 (55.2%) were female babies and 26 (44.8%) were male babies. The median age was 3 days. Cardiac, respiratory anomalies and hydrocephalus
were the most common accompanying problems. There were five cases of difficult intubation. There were no major anesthesia complications.
Conclusion: The management of infants with meningomyelocele and encephalocele requires up-to-date information about possible difficulties encountered
in perioperative management. Special anesthetic care is required to cope with difficult airway, presence of congenital anomalies, prone position and cardiorespiratory
disorders. Careful preoperative preparation and meticulous intraoperative management are essential for successful anesthesia practice.

Anahtar Kelimeler

Anestezi yönetimi, Ensefalosel, Meningomiyelosel, Zor entübasyon

Kaynakça

• Ravi KS, Divasha Hassan SB, Pasi R, Mittra S, Kumar R. Neural tube defects: Different types and brief review of neurulation process and its clinical implication. J Family Med Prim Care. 2021;10(12):4383-4390.
• Ugwuanyi U, Ayogu O, Onobun DE, Salawu M, Mordi CO. Encephalocele:A case series from abuja, North Central Nigeria. Cureus. 2022:17;14(3):e23249.
• Hamid RK, Newfield P. Pediatric neuroanesthesia. Neural tube defects. Anesthesiol Clin North Am. 2001;19(2):219-228.
• Mahajan C, Rath GP, Bithal PK, Mahapatra AK. Perioperative Management of Children With Giant Encephalocele: A Clinical Report of 29 Cases. J Neurosurg Anesthesiol. 2017;29(3):322-329.
• Yιldιrιm ZB, Avci E, Torun F, Cengiz M, Cigdem A, Karabağ H et al. Airway management for occipital encephalocele in neonatal patients: A review of 17 cases. J Neurosci Rural Pract. 2011;2(2):159-61.
• Quezado Z, Finkel JC. Airway management in neonates with occipital encephalocele: easy does it. Anesth Analg. 2008;107(4):1446.
• Manhas Y, Chinnan NK, Singh AK. Neonatal airway management in occipital encephalocele. Anesth Analg. 2006;103(6):1632.
• Nagappa S, Sridhara RB, Kalappa S. Comparing the Ease of Mask Ventilation, laryngoscopy, and ıntubation in supine and lateral position in ınfants with meningomyelocele. Anesth Essays Res. 2019;13(2):204-208.
• Devys JM, Mourissoux G, Donnette FX, Plat R, Schauvliège F, Le Bigot P et al. Intubating conditions and adverse events during sevoflurane induction in infants. Br J Anaesth. 2011;106(2):225-229.
• Singh H, Singh D, Sharma D, Tandon MS, Ganjoo P. Perioperative challenges in patients with giant occipital encephalocele with microcephaly and micrognathia. J Neurosci Rural Pract. 2012;3(1):68-70.
• Afroza S, Ali Z, Prabhakar H. Severe systemic hypotension during repair of leaking large Meningomyeloseller. J Anesth. 2008;22(1):59-60.
• Yeh WS, Kiohara PR, Soares IS, Carmona MJ, Rocha FT, Galvão CE. Prevalence of sensitivity signals to latex in meningomyelocele patients undergoing multiple surgical procedures. Rev Bras Anestesiol. 2012;62(1):56-62.
• Mahajan C, Rath GP, Dash HH, Bithal PK. Perioperative management of children with encephalocele: an institutional experience. J Neurosurg Anesthesiol. 2011;23(4):352-356.
• Leelanukrom R, Wacharasint P, Kaewanuchit A. Perioperative management for surgical correction of frontoethmoidal encephalomeningocele in children: A review of 102 cases. Paediatr Anaesth. 2007;17(9):856-862.